Group B streptococcus (GBS) is part of the normal vaginal flora of approximately 25% of healthy women. Unfortunately, GBS is associated with adverse pregnancy outcomes, due to in utero infection, and can cause serious infections in newborns, including pneumonia, sepsis, and meningitis. In this episode, Lakshmi Rajagopal and colleagues demonstrate that GBS promotes shedding of the vaginal epithelium, which in turn increases bacterial dissemination and ascending GBS infection. Importantly, prevention of epithelial exfoliation in murine models reduced ascending GBS infection and improved pregnancy outcomes.

Abstract

Thirteen percent of pregnancies result in preterm birth or stillbirth, accounting for fifteen million preterm births and three and a half million deaths annually. A significant cause of these adverse pregnancy outcomes is in utero infection by vaginal microorganisms. To establish an in utero infection, vaginal microbes enter the uterus by ascending infection; however, the mechanisms by which this occurs are unknown. Using both in vitro and murine models of vaginal colonization and ascending infection, we demonstrate how a vaginal microbe, group B streptococcus (GBS), which is frequently associated with adverse pregnancy outcomes, uses vaginal exfoliation for ascending infection. GBS induces vaginal epithelial exfoliation by activation of integrin and β-catenin signaling. However, exfoliation did not diminish GBS vaginal colonization as reported for other vaginal microbes. Rather, vaginal exfoliation increased bacterial dissemination and ascending GBS infection, and abrogation of exfoliation reduced ascending infection and improved pregnancy outcomes. Thus, for some vaginal bacteria, exfoliation promotes ascending infection rather than preventing colonization. Our study provides insight into mechanisms of ascending infection by vaginal microbes.